Robert Dudas, a practising consultant psychiatrist for older adults in England, has edited a collection of historical, philosophical and health service essays on psychiatry that is a welcome addition to values-based medicine. Dudas has a strong sense of psychiatry as both a ‘hybrid’ object and a humanistic endeavour. The object of psychiatry, he writes, is ‘configured by forms and practices of both the natural and the human sciences’, as well as by a constant encounter with values. Dudas locates his book in the historical work of psychiatrists German Berrios and Ivana Marková, as well as in the values-based teachings of psychiatrist/philosopher Bill Fulford.

Throughout the chapters we don’t lose sight of the complexities of working in England’s National Health Service and of navigating the conflicting social forces at play in psychiatry. Dementia, depression and borderline personality disorder are given values-based analysis. There are also interesting reflective chapters on the history of psychology and the ailments of mind by Dudas, and on narrative by Femi Oyebode.

A social force that is identified by Berrios and Marková in the first chapter on the origins of psychiatry as a profession is the ‘neuroscientific narrative of psychiatry’. Berrios and Marková see this narrative as historically contingent and, throughout the book, there is an ambivalence about its workability and suitability for values-based psychiatry. That sense of a narrative not working is noteworthy given that the book’s centre of gravity lies in discussion of dementia – psychiatry’s prototypical ‘organic disorder’. It makes the analysis more sophisticated because what is being reflected upon is not the relevance of the brain but the practicability of a certain kind of science narrative. The poor state of social care integration in multidisciplinary team approaches to dementia care, as well as the conceptualisation of dementia as more than memory, are points of departure for values-based chapters on dementia. With dementia now the UK’s leading cause of death, further values-based or normative and historically informed analysis of dementia – indeed of ‘organic psychiatry’ in general – feels particularly needed.

This is a thoughtful and learned collection in touch with the realities of real persons and real systems in healthcare. It seeks a humanistic narrative of psychiatry. Those strengths compensate for some unevenness in the spread of topics across 14 chapters ranging from long to short, and an overall arc midway between a sort of textbook and a collection of separated essays.